Avoid the pitfalls of solution-bias in health innovation


June, 2018
By Chris Lawer

In Brief

Health innovators need to choose the right units of analysis to guide the innovation task. Thinking about solutions or committing to one too soon, before gathering full evidence of health system priorities, unmet multi-stakeholder needs and unrealised outcomes introduces unnecessary risk, iteration, delay and cost. Worst of all, it can lead to failure. 

Current mindset

If health innovators are to help healthcare payers and providers achieve the Quadruple Aim - improved health outcomes, reduced costs, better patient experiences AND an enhanced experience for people providing care - they need to choose the right units of analysis to organise, focus and evidence the innovation task. Yet health innovation today remains dominated by solution-first thinking, or what I call solution-bias. Solution-bias is where companies begin the innovation task with a health technology or idea in mind (a type of device, a diagnostic asset, a drug molecule, some monitoring software, an app, etc.) without first fully understanding a) the nature and degree of the problem it is designed to address, b) if a strong value-based as well as commercial case can be made for it and c) whether patients or practitioners will even want it and use it. Solution-bias can lead to companies stumbling along the health innovation path, frequent u-turns, delays to market and worst of all, innovation failure. 

In the figure below, we depict the most common pitfalls of solution-bias in health innovation. Although the focus in this article is on health, these generally apply in many other complex markets too. Below we describe each of the pitfalls. 

Narrow search horizon

With solution-bias, companies define their markets, then search for and calibrate opportunities within narrowly set boundaries related to a particular solution or technology class or type. For example, a pharmaceutical company that is looking to develop a drug for weight loss will only compare the performance of the drug with other drugs in the same class rather than evaluating it against all types of weight loss solutions such as bariatric surgery or behavioural approaches such as mindfulness. A company that manufactures surgical drapes and gowns may define its market as operating theatre barrier products rather than the wider surgical infection prevention and control market.

When setting a market definition and search scope that includes a solution type or class, companies benchmark the health outcome and cost-resource effects of that solution with others in the same class. By doing so, an innovator risks ignoring adjacent innovation of different classes of solution that could have a bigger effect on the outcome or cost-resource element. Such adjacent technologies may mitigate the need for the company’s solution altogether and even diminish and ultimately, disrupt its market. 

Insights have limited shelf life   

Practitioners and patients use different health technologies and services in order to achieve their outcomes and meet a health goal. Technologies change rapidly over time yet generally, the goals they wish to achieve persist for much longer. Consider the health goal of close / heal a surgical wound (see figure below). Whilst the goal has persisted for thousands of years, the technologies used to achieve the goal - beginning with silk in Ancient Egypt through cat gut in the 10th century, then polymers, staples and now glue - come and go. The goal is stable yet the solutions are constantly in flux. 

Making a clear distinction between goals and solutions is important as it defines the focus and scope of enquiry for capturing unmet needs and defining problems. However, another important pitfall of solution-bias is that it typically only asks about the solutions people are currently using, or about the company’s solution being developed, not about the more stable goal, the outcomes users are seeking to achieve and the reasons why they cannot meet them.

Focusing on a solution at the outset means that the subsequent insights captured have a short shelf life and are unlikely to provide even medium - let alone long-term foresight. If your market research is on solutions, it is going to be pretty much out-of-date as soon as the report hits your desk. Innovation investments and strategic moves on this kind of input are inevitably more risky. 

Excess optimism clouds judgment

Another pitfall concerns the common inventor syndrome of having an unshakeable belief in the value of their idea. Unfortunately, starting the innovation task with a solution in-mind can quickly lead to a loss of objectivity and clouded judgment, especially when friends or only a limited number of potential customers are asked what they think of the solution. Excess optimism inevitably creates a personal and/or organisational filter that acts to block or dismiss any negative feedback. Such optimism, underpinned by emotional as well as financial commitment can lead innovators to modify, game or worse of all, ignore the true - possibly poor or limited - value of the solution to potential payers, practitioners and patients. 

KOL over-dependency

One tactic used for evaluating a solution, often at a late-stage, is to call in the experts. When such validation does occur, e.g., in an ad board, often only the expert opinion of a handful of key opinion leaders (KOLs) is sought. However, KOLs do not always hold, represent or comprehend less-expert practitioner and patient views. Nor may they be aware of important differences and nuances that exist in health practice amongst practitioners, across different care settings and geographies and away from their own experience. Unfortunately, positive KOL input does not necessarily guarantee innovation success. To make matters more complicated, often KOLs have different opinions and perspectives on the value of a solution, leading innovators more perplexed and unsure than before they asked them! 

Iteration cost and delay

The rigour of the health technology product development lifecycle (risk-analysis, clinical studies, verification, regulatory approval, user testing etc.) means that late modifications and adjustments to business cases, design and user requirement specifications can incur significant time and rework penalty, if change is even possible. Another drawback of early solution-bias in heath innovation is that over-committed product concepts have to be refined, adjusted, even scrapped, leading to unnecessary iteration and development cost, time-to-market delays and worse of all, again, failure. Being overtaken by competitors and disruptors is a common outcome of excessive solution-bias.

Value-case inputs too little, too late

Of course, having a clear idea and evidence of the market and user value of a solution is critical. Unfortunately, solution-bias can cause innovators to be overly concerned with the solution design and function at the expense of acquiring a deep understanding of its value. In other words, too much early emphasis on the molecule, the device mechanism, the test signal, the material dynamics or the software design for example, can detract from the necessity of capturing evidence of the health problem situation and critically, the specifics of the health system value case. Often the latter two are done too late and are not completed in sufficient detail, causing health innovators to pursue dead-ends with a solution that has insufficient value, or is not able to move the outcome needle enough for payers, practitioners or patients for them to consider using it. 

Chance adds failure risk   

Often, only by chance does an innovator successfully develop and commercialise a health solution. For every one new medical device, health technology or drug that makes it to market, there are thousands of failed or abandoned ones that do not. Even then, those that do make it to market may fail to achieve commercial goals or may be quickly disrupted by a competitive solution. The ultimate price for solution-bias is of course, failure.

Giving up is hard to do

Finally, ceasing interest and investment in a solution becomes much harder the further down the development path a health innovator gets. Bit of a cliche, but is probably true that the most difficult part of innovation is the “no” part – giving up on a solution - for all the above reasons - is the hardest thing to do.

Recalibrating health innovation 

So, what can be done? My view is that it always best to start the health innovation task with an outlook or mindset that is free of solutions - whether specific solutions, classes or types. Doing so gives the most appropriate frame for finding problems and opportunities in current health systems. It ensures that the innovation task proceeds as objectively as possible and with the greatest peripheral vision. It ensures that all stakeholder unmet needs and priority unrealised outcomes are identified, evidenced, compared and assessed before solution design. Overall, it provides a more appropriate scope for identifying important problems and then capturing the right inputs to more reliably and decisively explore, identify and/or validate opportunity to guide the innovation effort. 

In summary, the ability to meet the Quadruple Aim demands a reconsideration of the units of analysis needed to identify, define and target healthcare improvement and innovation opportunity. Yet unfortunately, current solution-biased approaches are akin to aiming a thousand bent arrows at an ill-defined and distant target in a gale-force wind. 

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